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4926 Johnson Dr., Shawnee Mission, KS 66205
Office Hours: Monday-Friday 9-5
Available by phone 24/7
913-384-5566

Vital Statistics Form

Please fill this form out as much as possible. It will help us to complete the death certificate and in writing the obituary. All fields with an asterisk are required.

Deceased's Information

If residence, please include address
mm/dd/yyyy
English, Irish, French, German, etc.
Be specific
Primary occupation during working years. *Do not enter \"retired\".
Sales, Medical, Engineering, Construction, etc.
Please list survivors and relationship: son, daughter, brother, sister, etc.
Religious affiliations, fraternal and civic organizations, hobbies, etc.

Informant's Information

A copy of what is submitted will be sent to this email.
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Obituaries & Condolences

John E. Boullear

Catherine Marie Dunlop

Sandra M. Vetter

Mary Lucille Jewett

Sue Istre

Elfrieda Roberta Gerner

William (Bill) Earl Claflin

Mary Louise Ray

Jerry Daniel Bontrager

George F. Berry

George Woodson Smith

Theresa Sue Davis

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